Detroit: COVID19 CLINICAL INFORMATICS PREPAREDNESS SHARED FROM THE FRONTLINES: HENRY FORD HEALTH SYSTEM

Submitted by:
Donna Summers MSN RN-BC, Informatics Nursing
Chief Nursing Informatics Officer – HFHS

Notes from the field:

“So first in Michigan (Detroit and Southeast Michigan) – we are not gearing up we are in the midst of a big surge so these are more of our actual actions.
The first day that Michigan declared a state of ER and The Federal Government as well – we came together as an IT team (Epic, Infrastructure, Analytics, Clinical Informatics) and discussed our response. We immediately initiated what we call our “go-live command center.” This was a well-established process from our Epic go-lives that all of our teams are familiar with the process. We have delivered on every request in the time needed so far. We also canceled our April Upgrade and training.” Donna Summer, MSN RN-BC CNIO HFHS

The following are notes from the field sent from the CNIO on how they have met the need so far. (Date: April 1, 2020)
Here is what Henry Ford Health System did:

1. Activated what we call our go live command center
2. Stopped all other work
3. Identified the top priorities and put efforts only toward those items
4. Documented and provided owners operational and Epic IT team to track work
5. Put Redeployed PM’s1 on two MACC2 groups (build new depts)
6. Twice daily meetings to check in and reprioritize work
7. Embed nursing informatics in site incident command centers to anticipate needs (leaders are too busy to reach out)
8. Daily team meetings to provide system and Helios updates to teams
9. Ability to quickly change current practice in order to expedite work. Examples:

1 PM=project managers
2 Healthcare MultiAgency Coordination Center (H-MACC)

1. Giving Epic access prior to training and then quickly creating elearnings and webinars. Because these areas are part of our teams we could move fast.
2. Clinical informatics people who can guide clinical build instead of waiting for others to direct.
3. Identifying change management and education needs.

10. Look at dashboard and capacity and make the decisions for the system to respond to.

Here is just some of the work HFHS has done since emergency declared – and Nursing Informatics has been instrumental

1. Average creating one to two more departments per day to increase both ICU and Med- Surg capacity (this is a multidisciplinary team that has now been working 19 days straight) and this is not slowing down.
2. Today (April 1, 2020) we are creating a Medical units in two ambulatory sites and two field hospitals to house in patients who are stable but can’t be transferred to SNIF’s because either the SNIF’s don’t have the ability to care for them or we are waiting for subsequent negative COVID tests.
3. Amazing Pathology Informatics people who were one of the first in the country to come up with a test so we were fortunate to have internal testing nearly from the beginning
4. Cancelled all nonemergent procedures/surgeries
5. Closed multiple clinics
6. Increased capacity for televisits and added using Haiku for televisits – we are averaging about 300 concurrent sessions now
7. Developed a Nursing Disaster Navigator with reduced documentation/policy – implemented this within 1 week of the disaster and so much needed (NIS, CNS). We copied Vanderbilt’s design and policy3. Used Epic’s idea but had to build ourselves using our content (Elsevier)
8. Asked to participate in a regional COVID strategy sharing meeting – we had implemented all of the recommendations but most of the participating hospitals had not. (We shared with Chicago hospitals what we built in our disaster navigator).
9. Started today on a RT disaster documentation – anticipating standalone vents in unusual places without device integration – need to shorten Vent documentation
10. Device integration and central monitoring is a big need as we go into unusual areas for patient care – they are as busy as our build teams
11. We have given as many as 3 Epic documentation roles to redeployed staff
12. Redeployed many people and nurses – created expedited access and on the fly eLearning training. (Thank God for the disaster navigator because we are just now training nurses to this.)
13. Screening tents, clinics were deployed in the first days
14. But it took us about >1 week to set up pools for results for notification
15. Employee plans for exposure, testing and back to work always evolving – biggest issue with surges is nursing staff. But also EVS, providers. (At one of our sites we have >100 staff awaiting results or recovery to come back to work.)
16. Updating Body disposition policies and documentation
17. Added a screening bot for patients
18. Used MyChart to send messages to patients

3 Tie to Vanderbilt’s Nursing Documentation recommendations—see additional resources

19. Developed dot phrases that have discharge instructions centrally and can be updated when changing
20. Worked with Healthwise to get basic discharge instructions, patient videos. Put in English and Spanish, but paid to get Bengali and Arabic too (large populations in our areas).
21. Really hard to help redeployed staff: AMB RN to IP, CRNA’s to ICU/ED or APP role, Techs, Aides, IP RN to ICU RN, – no end to the different combinations – so lots of access/training with elearnings and webinars by nursing informaticists
22. Stopped all onsite classroom training last week (not ideal in helping our RN’s who are redeployed). Even new hire nurses – webinars (not a best practice but only option right now)
23. Lots of NI support for CRNA’s in new roles – want to use their Anesthesia tools for an IP encounter – same with their perioperative nurse counterparts.
24. In general a lot of scared redeployed nurses both of COVID but also of their lack of experience in these specialties. Started this week with some alternate nursing models
25. Analytics, Analytics – everybody and their brother external to the health system wants data – one letter from VP Pence had approximately 72 data elements in it.
26. We were able to get basic dashboards going quickly – COVID admitted patients, pending tests, patients in isolation. Recently added our discharged alive and deaths. Doing our own predictive models related to our data only.
27. Employee testing dashboards, transfer data – now working on hand off preparation if we send patients to the newly planned FEMA field hospital.
28. Analytic challenge tracking capacity – we have to continually update as we change units to COVID, NON-COVID, ICU, GPU, Mixed acuity etc. . . .
29. Some absolutely phenomenal build done by our Epic team that fortunately has NI’s on it and our NIS. And thank goodness we have nurses – because operations can’t spare anyone to help us with order sets, bpa’s and triage build
    1. Triage system with auto-calculation of SOFA/mSOFA (amazing) and color codes. (Hoping we don’t have to do this but ready.)
    2. Order sets for terminal weans
    3. Comfort Hospice care orders – the protocols are really hard to follow and we anticipate some might happen outside our ICU’s. Influenced the decision to use an assessment score to determine actions. NIS developed a Visio and education. We go live with that tomorrow.
    4. Amazing pharmacist informatics people for complex order sets
    5. COVID order sets
    6. Constant movement of providers and clinics and then schedules too

“I am sure I missed at least 50 things because the pace is crazy. Glad to share with anyone who needs help. They should have a plan!”

Notes on staffing challenges:

“Frequent thanks and reminders that our clinicians have it worse than us (many have worked 14 days straight). Not good at thinking long term on staff and their ability to keep this pace. We have people that do not have back up. Good at short term; we have to figure out how we maintain this pace.”

Donna Summers MSN RN-BC, Informatics Nursing Chief Nursing Informatics Officer – HFHS

THANK YOU HENRY FORD HEALTH SYSTEM AND NURSES STAND STRONG!